Efficacy and safety of outpatient parenteral antibiotic therapy for infective endocarditis: a ten-year prospective study

Carlos Cervera, Ana del Río, Laura García, Marta Sala, Manel Almela, Asunción Moreno, Carlos Falces, Carlos A Mestres, Francesc Marco, Marga Robau, José M Gatell, José M Miró
Enfermedades Infecciosas y Microbiología Clínica 2011, 29 (8): 587-92

BACKGROUND: The length of treatment of infective endocarditis (IE) with parenteral antibiotics varies from 2 to 6 weeks. Although several studies indicate that outpatient parenteral antibiotic treatment (OPAT) could be safe for uncomplicated viridans-group streptococci (VGS) IE, the experience in Spain is limited and data on other types of endocarditis and OPAT are scarce worldwide.

METHODS: Prospective single center study of a cohort including all patients with IE admitted to the Hospital Clinic of Barcelona OPAT program from January 1997 to December 2006.

RESULTS: During the study period, 392 consecutive episodes of IE in non-drug abusers were attended to. Of these, 73 episodes (42 native-valve, 23 prosthetic-valve, and 8 pacemaker-lead) were admitted to the OPAT program (19%). The percentage of inclusion was higher for viridans group streptococci (VGS) or Streptococcus bovis (S. bovis) IE (32% of all VGS or S. bovis IE episodes diagnosed vs. 14% of the remaining etiologies, P<.001). Twelve patients (16%) were readmitted due to complications, of which 3 died (4%). Glycopeptides use was the only predictor factor of hospital readmission (OR 4.5, 95% confidence interval 1.2; 16.8, P=.026). No differences in OPAT outcome were found between VGS plus S. bovis IE and Staphylococcus aureus (S. aureus) plus coagulase-negative staphylococci IE. Patients spent a median of 17 day on OPAT (interquartile range 11-26.5), which enabled 1,466 days of hospital stay to be saved.

CONCLUSIONS: These data suggest that OPAT for IE may be a safe and effective therapeutic approach in the treatment of selected patients with types of endocarditis other than uncomplicated VGS or S. bovis endocarditis, although patients taking glycopeptides need close clinical OPAT monitoring.

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